Provider Demographics
NPI:1992198311
Name:KERR, SHELLY (PHD)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 GARDEN AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1934
Mailing Address - Country:US
Mailing Address - Phone:541-346-7444
Mailing Address - Fax:541-246-9089
Practice Address - Street 1:1901 GARDEN AVE STE 212
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1934
Practice Address - Country:US
Practice Address - Phone:541-346-7444
Practice Address - Fax:541-246-9089
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1500103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling